Mercea Petra A, Mischkulnig Mario, Kiesel Barbara, Wadiura Lisa I, Roetzer Thomas, Prihoda Romana, Heicappell Patricia, Kreminger Judith, Furtner Julia, Woehrer Adelheid, Preusser Matthias, Roessler Karl, Berghoff Anna S, Widhalm Georg
Department of Neurosurgery, Medical University Vienna, Vienna General Hospital, Waehringer Guertel 18-20, 1090 Vienna, Austria.
Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University Vienna, Vienna General Hospital, Waehringer Guertel 18-20, 1090 Vienna, Austria.
Cancers (Basel). 2021 Feb 3;13(4):603. doi: 10.3390/cancers13040603.
Complete resection is an indispensable treatment option in the management of brain metastases (BM). 5-aminolevulinic acid (5-ALA) fluorescence is used for improved intraoperative visualization of tumor tissue in gliomas and was recently observed in BM. We investigated the potential of 5-ALA fluorescence to visualize the infiltrative growth of BM in the peritumoral brain tissue and its histopathological correlate. Patients with BM resection after 5-ALA administration and collection of tissue samples from peritumoral brain tissue were included. Each tissue sample was histopathologically investigated for tumor cell infiltration and angiogenesis. Altogether, 88 samples were collected from the peritumoral brain tissue in 58 BM of 55 patients. Visible 5-ALA fluorescence was found in 61 (69%) of the samples, tumor infiltration in 19 (22%) and angiogenesis in 13 (15%) of samples. Angiogenesis showed a significant correlation with presence of fluorescence ( = 0.008). Moreover, angiogenesis was related to visible 5-ALA fluorescence and showed an association with patient prognosis since it was significantly correlated to shorter time to local progression/recurrence ( = 0.001) and lower one-year survival ( = 0.031). Consequently, angiogenesis in the peritumoral brain tissue of BM might be a novel prognostic marker for individualized perioperative treatment concepts in the future.
完整切除是脑转移瘤（BM）治疗中不可或缺的治疗选择。5-氨基乙酰丙酸（5-ALA）荧光用于改善胶质瘤术中肿瘤组织的可视化，最近在脑转移瘤中也有观察到。我们研究了5-ALA荧光在可视化脑转移瘤在瘤周脑组织中浸润性生长及其组织病理学相关性方面的潜力。纳入了在给予5-ALA后进行脑转移瘤切除并从瘤周脑组织采集组织样本的患者。对每个组织样本进行组织病理学检查，以评估肿瘤细胞浸润和血管生成情况。总共从55例患者的58个脑转移瘤的瘤周脑组织中采集了88个样本。在61个（69%）样本中发现可见的5-ALA荧光，19个（22%）样本中有肿瘤浸润，13个（15%）样本中有血管生成。血管生成与荧光的存在显著相关（P = 0.008）。此外，血管生成与可见的5-ALA荧光相关，并且与患者预后有关，因为它与较短的局部进展/复发时间（P = 0.001）和较低的一年生存率（P = 0.031）显著相关。因此，脑转移瘤瘤周脑组织中的血管生成可能是未来个体化围手术期治疗方案的一种新的预后标志物。
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